Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA.
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA.
Paediatr Perinat Epidemiol. 2022 Nov;36(6):771-781. doi: 10.1111/ppe.12887. Epub 2022 May 16.
Women with endometriosis may have an increased risk of adverse pregnancy outcomes. Research has focused on infertility clinic populations limiting generalisability. Few studies report differences by endometriosis severity.
We investigated the relationships between endometriosis diagnosis, staging and typology and pregnancy outcomes among an operative and population-based sample of women.
Menstruating women ages 18-44 years enrolled in the ENDO Study (2007-2009), including the operative cohort: 316 gravid women undergoing laparoscopy/laparotomy at surgical centres in Utah and California; and the population cohort: 76 gravid women from the surgical centres' geographic catchment areas. Pregnancy outcomes were ascertained by questionnaire and included all pregnancies prior to study enrolment. Endometriosis was diagnosed via surgical visualisation in the operative cohort and pelvic magnetic resonance imaging in the population cohort. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using generalised linear mixed models for pregnancy outcomes, adjusting for women's age at study enrolment and at pregnancy, surgical site, body mass index and lifestyle factors.
Women in the operative cohort with visualised endometriosis (n = 109, 34%) had a lower prevalence of live births, aPR 0.94 (95% CI 0.85, 1.03) and a higher prevalence of miscarriages, aPR 1.48 (95% CI 1.23, 1.77) compared with women without endometriosis. The direction and magnitude of estimates were similar in the population cohort. Women with deep endometriosis were 2.98-fold more likely (95% CI 1.12, 7.95) to report a miscarriage compared with women without endometriosis after adjusting for women's age at study enrolment and at pregnancy, surgical site and body mass index. No differences were seen between endometriosis staging and pregnancy outcomes.
While there was no difference in number of pregnancies among women with and without endometriosis in a population-based sample, pregnancy loss was more common among women with endometriosis, notably among those with deep endometriosis.
患有子宫内膜异位症的女性可能有不良妊娠结局的风险增加。研究集中在不孕诊所人群，限制了其普遍性。很少有研究报告子宫内膜异位症严重程度的差异。
我们调查了在手术和人群样本中，子宫内膜异位症的诊断、分期和分型与妊娠结局之间的关系。
2007 年至 2009 年，年龄在 18-44 岁之间的月经妇女参加了 ENDO 研究，包括手术队列：316 名在犹他州和加利福尼亚州手术中心接受腹腔镜/剖腹手术的孕妇；人群队列：76 名来自手术中心地理服务区的孕妇。通过问卷调查确定妊娠结局，包括研究入组前的所有妊娠。手术队列中通过手术可视化诊断子宫内膜异位症，人群队列中通过盆腔磁共振成像诊断。使用广义线性混合模型调整妊娠结局的调整患病率比 (aPR) 和 95%置信区间 (CI)，调整妇女在研究入组时和妊娠时的年龄、手术部位、体重指数和生活方式因素。
手术队列中可视化子宫内膜异位症的妇女（n=109，34%）活产率较低，aPR 为 0.94（95%CI 0.85，1.03），流产率较高，aPR 为 1.48（95%CI 1.23，1.77）与无子宫内膜异位症的妇女相比。人群队列中估计的方向和幅度相似。调整妇女在研究入组时和妊娠时的年龄、手术部位和体重指数后，深部子宫内膜异位症妇女报告流产的可能性是无子宫内膜异位症妇女的 2.98 倍（95%CI 1.12，7.95）。子宫内膜异位症分期与妊娠结局之间无差异。
在人群样本中，有和没有子宫内膜异位症的妇女的妊娠次数没有差异，但子宫内膜异位症妇女的妊娠丢失更为常见，尤其是深部子宫内膜异位症妇女。
